'From blood donation to transfusion, the entire chain is full of gaps'

[00:00:00] Hello and welcome to all Indians Matter, I am Ashraf Engineer.

[00:00:03] It is estimated that every two seconds, someone somewhere requires a blood transfusion.

[00:00:08] These included leukemia and hallucinous patients, pregnant women, accident victims and

[00:00:12] those undergoing surgeries.

[00:00:13] These and so many others depend on blood transfusion.

[00:00:16] It's quite literally a matter of life and death.

[00:00:19] What's more according to a World Health Organization report in low-income countries up to 54%

[00:00:24] of blood transfusions are given to children under five years of age.

[00:00:28] Now in four maternal deaths in India is due to blood loss.

[00:00:30] However, even today, many who require transfusions do not have access to safe blood.

[00:00:36] In the also faces a clear gap between demand and supply of blood according to 2021 statistics,

[00:00:41] the demand supply ratio is 1.46 billion units to 1.25 billion units.

[00:00:45] The shortage has dire consequences leading to more than 12,000 deaths every day.

[00:00:51] With blood donor day coming up in June 14, there's a lot to think about.

[00:01:02] We are on the show Anuba Tanajya Mukherjee, member secretary, Thaleseen Mia patient at

[00:01:05] Bakosy Group, a lawyer by training at Thaleseen Mia herself Anuba has been working for the

[00:01:10] cause of Thaleseen Mia for years.

[00:01:11] She is a respected voice and blood safety and represents the Thaleseen Mia patient at Bakosy

[00:01:15] Group as a special invite to the National Black Transfusion Council under the Ministry of Health

[00:01:20] and Family well-famous.

[00:01:21] Anuba is also a member of the Thaleseen Mia patients at Bakosy Group of the Thaleseen Mia International

[00:01:26] Federation at Quartered in Cyprus.

[00:01:27] Anuba, welcome.

[00:01:29] Hi, Ashraf.

[00:01:30] Anuba, we have had lots of conversations about lack of beds and ventilators that impacted

[00:01:35] health care delivery severely in the wake of the COVID-19 pandemic.

[00:01:39] However, ongoing shortages andemic problems like the lack of safety of blood are not discussed

[00:01:44] widely.

[00:01:45] Maybe because you see them every day, why safe blood is so critical to health care?

[00:01:50] Thanks for that question Ashraf.

[00:01:52] I think it's a very important question.

[00:01:55] And I think it is strange that we even asked the question why is this important because

[00:02:04] it's like asking why is safe water important?

[00:02:08] Why is safe air important?

[00:02:10] You know, there's so much to talk around air quality air pollution and one wonders as to why

[00:02:16] there isn't so much to talk about safe blood.

[00:02:18] It is important because unsafe blood leads to uncontrollable diseases like HIV.

[00:02:26] It leads to mortality by transfusion transmitted infections like it's CV HIV.

[00:02:33] Look at it this way that a patient or phalosy Mia is going for transfusion.

[00:02:40] Thinking that he or she will come back all charged up and will come back with a

[00:02:46] list of life.

[00:02:48] But a couple of days later he or she discovers that he has actually contracted

[00:02:53] something as dangerous as HIV or HIV.

[00:02:58] Worse is this also think of a situation where somebody who's absolutely

[00:03:04] all right in terms of health met with an accident and has to undergo a surgery and receive blood

[00:03:12] transfusion. And while he recovers from the accident per se, he discovers that she has

[00:03:19] contracted hepatitis C or HIV and these diseases, these infections are really dangerous

[00:03:31] and life threatening in the sense that they're very painful in terms of their cure and some

[00:03:37] of them are not even cureable. That according to me is why talking about safe blood is very important.

[00:03:46] Aloha it's also not just about the quality of blood but also inadequate supply of blood

[00:03:51] isn't it? A single blood donation can save up to three lives and donations are not used

[00:03:55] only for transfusions, but also to create blood derivatives for treating various medical conditions.

[00:04:01] Yes that's right, Ashraf and it is very surprising that in a country of 1.3 billion.

[00:04:12] We definitely have loads to be proud of but I think population is something that really gives us an

[00:04:21] edge what we call demographic dividend today but it's very strange that in a country of

[00:04:28] from 1.31 40 crore people we have poverty of blood. It is a reality though it is primarily because

[00:04:38] of lack of awareness but coming back to your question yes a single blood donation can actually

[00:04:45] give you not only one bag of life but also many bags of life if you like because there are

[00:04:53] components like red blood cells, leukocytes, plasma and these components can be used for various

[00:05:01] patients. So while plasma can probably be used for somebody suffering from dengue, RBCs can be

[00:05:10] used for patients of phalicemia. So yes one bag of blood can actually give you around three

[00:05:17] components at one go. Also I think there is a lot of lack of awareness there is a lot of misconception

[00:05:24] about blood donation how does this exacerbate the problem? So that is essentially because people

[00:05:32] really haven't been told enough about voluntary blood donation, people haven't been told about

[00:05:41] how much need is there when it comes to blood donation. There are all sorts of myths like

[00:05:48] I clearly remember when I was in law school and there was a student who wanted to donate for me

[00:05:56] her mother actually told her that this might have an impact on her fertility and she told her

[00:06:02] that she could probably choose to donate blood after marriage but not before that. So I was very

[00:06:08] surprised because these were very educated people and I'm sad to share with you that after COVID

[00:06:16] this tendency has only increased, because people don't know enough about blood donation. They don't

[00:06:24] know how good it is and how much it is essential for some people and also they think that they

[00:06:33] might lose their fertility, they might get some kind of infection that is the reason why they

[00:06:40] you know they are not sure whether they want to donate or not. A critical sense of how

[00:06:44] prevalent transfusion transmitted infections such as hepatitis V and C and H I V R? So while

[00:06:51] there is a plethora of data available about prevalence of hepatitis C, H I V etc but

[00:07:00] you know there was a research which was done and you know there are many, many reports and many

[00:07:06] studies but the one that I'm referring to said that more than 50% out of a sample of 196 blood

[00:07:16] transfusion dependant patients that were in that study more than 50% were positive for anti-HCV

[00:07:24] while for HIV the percentage was much lower and I'm sure there are many studies like that this is

[00:07:32] this is essentially because a patient of thalisemia is going for blood transfusion almost every 15

[00:07:39] days. So you can imagine the kind of you know the kind of danger and the kind of threat to life

[00:07:48] and that is why you know the proneness or the skip ability to you know these infections is

[00:07:56] much higher and the prevalence of it's V HIV in such patients is much higher than in normal

[00:08:02] people. There seem to be a lot of gaps in the blood safety process where are the problems

[00:08:09] in the collection and screening process and what can we do to plug that gap?

[00:08:14] So these gaps are sure of our at many places across the value chain if I can use that very

[00:08:23] corporate world in this you know subject as well. So you know blood transfusion services

[00:08:31] are a gamut of activities that are done starting from blood collection to blood administration.

[00:08:39] So you know from point zero to point ten our regulatory framework is full of gaps. So for

[00:08:48] instance if I'm collecting blood then I'm supposed to look at donor counseling. I'm supposed

[00:08:56] to counsel the patient you know properly it's called hemovidulence. I need to be vigilant about

[00:09:02] the patient's history that is not done and that is more of a matter of implementation rather than

[00:09:10] gap in the regulatory framework. So that is one area you know that is one gap that can be plugged

[00:09:16] properly by talking to the patient to the donor by counseling the donor asking the donor the right

[00:09:23] questions but an India you know when people go for donation I have not seen such thorough counseling

[00:09:30] anyway after one has donated blood then comes the screening which is an absolutely important part

[00:09:39] of the whole you know process. Now here is according to me the biggest gap because in India

[00:09:48] and hold your breath because there is no single screening with dology that is mandated. So for

[00:09:57] instance there are 3,000 banks blood banks in India these 3,000 blood banks are absolutely

[00:10:06] free to use the screening methodology that they want to you heard me right. So while you know

[00:10:13] there is a card test which they call rapid test to the best of my knowledge which is a which is

[00:10:19] of you know 100 to be test to nucleic acid amplification testing which is the goal standard

[00:10:27] in blood seeks screening across the world. The blood bank is free to choose any test that they want

[00:10:32] to do and you can you know it can be anybody's guess as to which one let's say a blood bank

[00:10:41] in the inner most area of rural you know area the blood bank will choose. So that according to

[00:10:49] me is a huge gap and then comes the administration point now the administration point is where

[00:10:57] the doctor is actually giving blood and the and the blood bank is actually doing profile matching

[00:11:05] lucocide depletion filtering so that is also something that's not mandatory. So for instance

[00:11:12] patients of Salisemia there is on very well to lucocide depleted blood and because they take

[00:11:19] blood so frequently it is extremely helpful to do profile matching for them which is not done in

[00:11:27] India. So I have talked about how from donation to transfusion the whole chain is so full of gaps.

[00:11:38] Now how can it be a dress I think that was the second part of your question. I think it can be

[00:11:45] addressed by coming up with a comprehensive blood law for the country. Today we have a national

[00:11:54] blood transfusion council which is making guidelines for blood transfusion services in India. But

[00:12:02] guess what this is a council which doesn't have teeth in the sense that it is issuing guidelines

[00:12:10] which are just that guidelines they are not directions they are not orders of mandates. MPTC is not

[00:12:18] a regulator the regulator is you know under the drugs and cosmetics act. So it's a very fragmented

[00:12:26] regulatory framework and according to me the government needs to come up with a consolidated framework

[00:12:33] for blood transfusion services it can be called the blood law and it should have mandate for blood

[00:12:40] screening if not anything else. Absolutely I couldn't agree more and but before we proceed

[00:12:45] I should just tell listeners that when Anuba first to the NBTC she is referring to the National

[00:12:50] Blood transfusion council. Anuba I'm glad you raised the issue of regulation and you know

[00:12:56] your spot on that there is no real blood law as such I think the laws that come into question are

[00:13:02] the drugs and cosmetic rules of 1945 pursuant to the drugs and cosmetics act of 1940 which is that

[00:13:08] all blood samples must be tested for serious infectious diseases we are talking about HIV1 and to

[00:13:13] hepatitis B and C malaria parasites syphilis. Is this being done rigorously and I'm asking

[00:13:20] and I am aware that you've touched upon part the question earlier but I'm asking this again because

[00:13:25] it might be such at least one paper referred to Indian blood banks as cotton coat dangerous ones.

[00:13:33] So Ashraf for me the question is not whether they are doing this rigorously I mean what would

[00:13:42] you call rigorously is my problem is my question because if the law doesn't even define

[00:13:50] what is rigorous is a car test rigorous enough because then the blood bank will come and say that look

[00:13:58] you said that I have to test every blood bag for HIV it's CV, malaria,

[00:14:06] blood-clap parasites so on and so forth and I'm doing that so I'm compliant I'm compliant with the

[00:14:13] law and this is rigorous testing for me because you haven't even defined what the blood bank

[00:14:20] should use that you would call rigorously. So it is very difficult unless there is a uniform

[00:14:27] mandate across the country I will give you an example to explain this now because there is no

[00:14:34] standardized blood screening methodology that has been mandated by the countries,

[00:14:41] policy makers somebody sitting in Delhi in a hospital in Delhi is getting an act tested blood

[00:14:52] which is lucosite depleted profile matched voluntarily donated and somebody sitting in dark

[00:15:01] is getting a blood bag which has been given by a replacement donor there has been

[00:15:08] no adequate hemovidulence and there has been no confidence separation the person is getting

[00:15:14] whole blood and probably a laser testing or car testing has been done on that blood back

[00:15:23] and these both are hallucinous patients both sitting in the same country, both suffering from

[00:15:29] the same problem so then what would you call rigorous you know because what to one is rigorous

[00:15:37] to the other person it's you know rudimentary. So I think we need to bridge this yeah.

[00:15:45] So I mean while you've already talked about the need for a blood law comprehensive blood

[00:15:49] law that applies to the entire country could you talk a little bit more about that I was actually

[00:15:53] going to ask you about the regulations around blood screening in India but you've already talked

[00:15:57] about that could you talk a little bit more about this blood law or what could its components be

[00:16:02] what would it look like. So let me go back into history of it and being a lawyer I love to talk

[00:16:12] about judgments and statutes so I think you've given me that opportunity with this question.

[00:16:19] While in my earlier answer I touched upon it but let me tell you that you know there was a

[00:16:27] common cause judgment in 1980s, 90s I'll have to look up the date but it's an old judgment

[00:16:36] where it was the direction of the Supreme Court to set up national blood transfusion council

[00:16:43] in BTC and along with that the Supreme Court had given many other directions amongst which was

[00:16:52] that the policy makers should consolidate the regulatory framework of the country that has not

[00:17:01] been deleted. So what I'm talking about is not something that Anugata Naja out of the blue sky

[00:17:08] is suggesting this is something that was directed by the court, the epic court of the country

[00:17:16] many many decades ago. Now when I talk about consolidated blood law what I mean

[00:17:24] is that first of all you have one regulator for regulating blood transfusion services in India.

[00:17:33] You cannot have one macodowing something then one NBTC laying the guidelines then now there

[00:17:41] is DGHs in the picture directory general of health services, one hears that the whole blood transfusion

[00:17:49] dispensation and policy making is now under DGHs suddenly then there is national health

[00:17:56] mission which is taking care of calisimics and then you have your you know drug controller

[00:18:03] of India who's actually the regulator under the drugs and cosmetics act. You got confused right

[00:18:11] because it is confusing because it is so fragmented anybody I mean we are getting them

[00:18:17] so imagine somebody sitting in you know let's say CDSCO which is the authority they are only

[00:18:27] you know they are only qualified to license the blood banks and they treat blood as a drug

[00:18:37] under the drugs act blood is not supposed to be treated as drug. So the role of these people

[00:18:44] are limited is limited to giving license to the blood banks that's it whether the

[00:18:50] infrastructure is okay or not whether they are following all the guidelines or not then NBTC is

[00:18:56] rolling out certain guidelines then NACO is rolling out something so what I'm suggesting here and

[00:19:01] what we at calisimia patients at gochasee groups suggest is that all these threads should come

[00:19:09] together to form a blood law the blood law should have mandates standardized system of

[00:19:19] screening hemobudulence whatever it is related to the blood transfusions services in India

[00:19:24] it should be all uniform and it should be under one regulator it should be under one law

[00:19:32] and it should be administered by one authority because if you can have one nation one GST

[00:19:38] one nation one grade I really don't understand why you can't have one nation one blood.

[00:19:45] Absolutely and before I continue to the next question I should inform listeners that NACO is

[00:19:50] the National AIDS Control Organization while the CDSCO is the central drug standard control

[00:19:55] organization. However as I was researching this episode I came across something pretty interesting

[00:20:00] more form of testing called the nuclear cacid amplification testing and that seems to be

[00:20:05] quite interesting a lot of people are talking about it what can you tell us about it?

[00:20:10] So I can only tell you what a patient and a lawyer should tell you. I would not

[00:20:16] assume the authority to know the medical part of it but I can tell you bases my research

[00:20:25] and whatever I have read of whatever judgments I have seen that it is understood to be the goal standard

[00:20:32] for blood screening across the world to the best of my knowledge it has been adopted as

[00:20:40] mandates of blood screening by many countries like the US or Australia and in India also wherever

[00:20:49] I have gone I have spoken to DGHS I have spoken to Ministry of Health Officials. I have not heard

[00:20:59] anyone say this is not the best. The only thing I have heard people say is letters roll it out in a

[00:21:08] phased manner it is going to take you know it is expensive now now in India you know I think it's

[00:21:16] very easy to just pin things onto cost if you do healthcare economics study and if you look at

[00:21:26] look at the you know other side of the coin how many people are we losing to transfusion

[00:21:32] transmitted infections what is the kind of money we are spending on the cure care and management

[00:21:40] of hepatitis C of patients who have got infected with hepatitis C if you compare both and sure it

[00:21:47] will be worth it but has anybody done that and not sure so coming back to the question

[00:21:54] Nat is absolutely the goal standard for blood screening and aims daily has adopted Nat

[00:22:02] I know for a fact that Apollo Delhi and many hospitals of Apollo and many good blood banks

[00:22:09] they are adopting Nat as a best practice. I am given to understand what Nat does is that it increases

[00:22:17] the window time so basically when somebody gets infected there is a window time there's a window

[00:22:25] period which means that the virus would take that much time to actually get detected by any

[00:22:33] kit or any test. Now if in a certain case that window period let's say is for 15 days

[00:22:41] if I get infected with it's CV today and I go and donate blood when they test it with let's say

[00:22:49] Eliza or any other maybe a rudimentary test. I will come as it's CV negative I will come as

[00:22:57] hepatitis negative and that blood will be administered to somebody but maybe a couple of days later

[00:23:04] that virus will show itself it will manifest in the screening but in case of Nat I understand

[00:23:14] that the window period is very less so if I get infected today the chances of you know that

[00:23:23] the virus getting caught or getting spotted in a test maybe next day or in very less time

[00:23:31] is very high. So what it does is that it filters it filters and and it can be Nat can be used as

[00:23:38] a layer above Eliza and it increases the chances of virus detection I have even read that

[00:23:47] you know it's 99.99% foolproof so that's what Nat is. Is it widely available in India?

[00:23:55] See there's no problem of availability the only problem is that of intent the only

[00:24:00] problem is that of awareness like I just said that I know for a fact that all my fellow patients

[00:24:08] you know I go to a government hospital and they go to if somebody goes to a pollot they are getting

[00:24:15] Nat I'm not getting Nat but some government hospitals are also using Nat so for instance RML has

[00:24:21] Nat aims has Nat so of course I would like to believe that if it is available in so many hospitals

[00:24:29] all the government and also available in private hospitals it has to be quite widely available.

[00:24:37] So availability is not an issue the issue is only that of intent and understanding and getting

[00:24:43] convinced that this is something that the patients require instead of thinking that okay when

[00:24:49] when they get infected then probably will cure hepatitis let's not spend money on Nat I mean

[00:24:56] that's the thinking I'm not sure whether that's the thinking.

[00:24:58] Oh well there's been a suggestion that in a decentralized and fragmented

[00:25:02] geography like India centralization of blood banks for Nat testing should be the norm do you agree

[00:25:08] and yes how would such a system work? See again I would not like to assume authority here

[00:25:17] and say that I agree or I disagree because then I'll have to give medical reasons which

[00:25:24] I'm not completely in control of but what I can tell you is that DGX like I said DGX now is in charge

[00:25:34] it is actually the policy making body for blood transfusions services in India now.

[00:25:38] I know for a fact that DGX really supports the centralized system of blood banking it is again a

[00:25:49] standard across the world that the system of blood banking should be centralized because it is

[00:25:55] also I think common sense also tells me that it is optimum resource utilization because if you

[00:26:03] have Nat for instance in aims let's look at the example of Dali. If we have Nat and aims Dali

[00:26:10] and that hospital supplies to LHMC or MLDDU all the hospitals of Dali.

[00:26:18] I think it makes a lot of sense because you don't have to add infrastructure then you already

[00:26:27] have that setup in Man Hospital and you can supply to others but I'm not sure given the

[00:26:34] kind of country we are. I don't know how they will manage the whole transportation

[00:26:40] of it because in other countries they even fly blood from one city to the other and I don't know

[00:26:47] with the kind of temperatures required how that will really happen how that will really work out

[00:26:54] on the ground but I definitely know because being a special invited to NBTC I have heard DGX talk

[00:27:02] about centralized blood banking and it is definitely the way to go.

[00:27:09] So on about tell us about the Thalesimia patient at the advocacy group what has his journey been like

[00:27:13] and what kind of impact has it had? So Thalesimia patients at advocacy group TPAG for short

[00:27:22] it was setup in 2017 by the then deputy chief minister of Dali and it was set up by 7 adult

[00:27:33] Thalesimia patients including myself this is not our day job but we thought that let's get

[00:27:41] together and work for the overall interest of Thalesimia and prevent Thalesimia in India so this

[00:27:50] is the mission of TPAG. When I say overall interests they chose this expression very deliberately

[00:28:00] because for a long time now there has been a lot of emphasis on the medical advancements that

[00:28:07] Thalesimia should live a normal life and medically you know they should be taken care of but

[00:28:14] being Thalesimia ourselves we thought that we should also look at the other aspects like social

[00:28:21] economic aspect like legal aspect right to live right to say blood we should look at psychological

[00:28:29] aspect because Thalesimia is not only about blood transfusion every 15 days it comes with a lot

[00:28:37] of complications because you have iron getting overloaded on your body so you need regular

[00:28:44] iron curating agents and drugs then you need the blood to be safe you you have you are prone

[00:28:51] to cardiac problems hepatic problems. So we thought what is the impact you know psychological

[00:28:57] impact of such a life such a complicated life. So we said let's look at the psychological aspect

[00:29:06] also then the thought let's also look at the legal aspects because Thalesimia is a disability

[00:29:12] under the rights of persons with disabilities at 2016 so let's ensure that the benefits which are

[00:29:22] stipulated in the law they are given to us so so this was our thinking that we should work on

[00:29:29] the non-medical aspects of Thalesimia and we should do ad walkacy. So if you see TPAG we are not so much

[00:29:38] into blood donation camps per se or on the ground activities we work very closely with the

[00:29:44] policy makers and our tool is essentially ad walkacy we try to you know bring new policies work

[00:29:54] with the government to formulate new policies favorable policies for the prevention management and

[00:29:59] treatment of Thalesimia and today we are around 35 of us across India and the journey has been

[00:30:09] absolutely spectacular. Of course we are a little slow as an organization because we are all employed

[00:30:16] we are doctors lawyers engineers also in addition to being Thalesimics but I think TPAG has played a

[00:30:26] great role especially during COVID because during COVID there were a lot of problems that our

[00:30:34] community was facing we were not getting blood to start with we were not getting pads so so we

[00:30:40] worked with the government closely to ensure that our fellow patients got whatever they needed we

[00:30:48] work we worked very closely with the government on on blood safety so we have established a

[00:30:56] Nat lab in red cross Delhi red cross HQ Delhi so that's one of our best campaigns so far

[00:31:05] we are as I speak you know we are associated with the Confederation of Indian industry

[00:31:12] for a campaign called Save Blood Campaign and ahead of this world Halesimia day on 8th

[00:31:20] may we are actually organizing a lot of blood donation campaigns we do humongous media advocacy

[00:31:27] because we know we can't do so much on the ground so we you know getting touched with a lot of

[00:31:33] doctors other influencers and we invite them, follow me in their hands and we invite them to

[00:31:40] you know talk about Thalesimia so this is our way of creating awareness about Thalesimia awareness about

[00:31:47] safe blood awareness about new therapies because Thalesimia treatment is also now becoming

[00:31:54] a reality and the lot of therapies like gene therapy and blood dependent reduction therapies

[00:32:01] that are in the market so we talk a lot about these things and what comes next for it?

[00:32:07] Bloodlog absolutely because we have been talking it's it's been it's been

[00:32:14] long time since we've been talking about bloodlogs to the government and now we are planning to come

[00:32:20] up with a draft and present that draft to the government we are in touch with Hesocham and CIF for

[00:32:28] this and in the lawyer myself I myself also working on this then there are a couple of

[00:32:35] litigations that we are kind of following those litigations are by transgenders because transgenders

[00:32:42] are not allowed to donate blood wall entirely and they're asking for that like a for that right

[00:32:48] in the Supreme Court of the country so we are kind of following how that litigation goes and

[00:32:53] and one of us has even filed an application in that petition to say that you can allow this

[00:33:01] only if you have net because you can't throw the baby with the bathwater you can't allow this

[00:33:07] and not have net so those are also some of the things that we are doing but bloodloat is definitely

[00:33:13] the next also getting disability related benefits for employment because right now Salicy

[00:33:21] mix have reservation as far as education is concerned but we don't have any reservation

[00:33:27] as far as employment is concerned today Salicy mix are doing it's truly well you will meet

[00:33:33] people who have you know who have become doctors and and I a softesters but I think if they're

[00:33:40] given a little more support then we have many more people who can become doctors and lawyers and

[00:33:45] ISO officers and whatever they want to become so that is definitely there and one of the most

[00:33:53] important things that we are gunning for is access to new treatment therapies because one here's

[00:34:01] that across the world patients are getting access to gene therapy patients are getting access

[00:34:09] to new therapies which reduce you know the duration between two blood transfusions and we don't

[00:34:15] understand why India being the Salicy Mia capital of the world should not have access to such

[00:34:22] therapies so we definitely want to work towards that and above all we want to create awareness

[00:34:30] in general about Salimia urge people to go and get themselves green for Salimia because it is a

[00:34:39] very simple test we want to tell people it's not worth it I mean just avoiding one test and then

[00:34:46] having a child who has to go through this kind of life where they are dependent or transfusions

[00:34:54] and they are prone to so many other complications it's not worth it I mean if you take an

[00:35:00] informed decision that you still want that child then I mean go ahead but at least one should

[00:35:06] have that knowledge that I can get this test done and prevent Salimia forward so so I think prevention

[00:35:13] of Salimia is also top of the list so all about years a question I asked all my guests at the end

[00:35:21] of the show why do you do this work I do this work because I think this work has chosen me there

[00:35:29] have been times when I have told myself that I want to focus on law and law alone because

[00:35:38] that is absolutely first love for me I have been an operator and and there have been many times

[00:35:44] when I told myself that I don't want to do Salimia work and why am I doing Salimia work but

[00:35:50] I have realized that I haven't chosen Salimia Salimia has chosen me I also do this work because

[00:35:59] I think that you know when I was studying English literature I read the poem

[00:36:08] record the Deutschland and in that poem the poet is saying that God chooses you through

[00:36:16] flowers to sunshine to good things but God also chooses you through tempest he touches you through

[00:36:25] fury also and that settled in my mind and I told myself that God has chosen me through

[00:36:31] Salimia and if inspired of Salimia I have made it big with the support of my family it is

[00:36:40] actually my duty that I should give it back to the society and I should work for Salimia I

[00:36:47] should spread awareness that is that is why I work for Salimia because Salimia has chosen me

[00:36:53] and I think I don't really have an option. Anuba thanks so much for being on the show.

[00:36:58] Thank you Ashraf and it was a great opportunity to be on this popular show with you and before

[00:37:07] I take your leave I would just like to urge everybody who's listening to this podcast

[00:37:13] that please go and get yourselves tested for Salimia this eighth May which is world blood donor

[00:37:22] and also if you are eligible then please go and donate blood on 14 June which is National

[00:37:30] Wallantry Blood donation day and please be aware and wherever wherever you see the risk of spreading

[00:37:38] information and awareness about disorders like Salimia please do that thank you.

[00:37:45] Thank you all for listening please visit all Indians matter dot in that say double L

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